Rate of treatment success and associated factors in the program for drug-susceptible tuberculosis in the Forest Region, Republic of Guinea, 2010-2017: A real-world retrospective observational cohort study

•Drug-susceptible tuberculosis program in the Forest Region, Republic of Guinea.•The WHO goal of 90% treatment success remains elusive in rural areas.•TB-HIV coinfection remains a major risk factor for low treatment success.•Older age and long travel distance are also associated with low treatment success. To analyze the treatment success rate (TSR = sum of cured or treatment completed) in the tuberculosis (TB) program for drug-susceptible TB (DS-TB) at the “Centre Hospitalier Régional Spécialisé” in Macenta, Forest Region, Republic of Guinea. This cohort study included patients who started treatment for DS-TB between 2010 and 2017. Data collection was part of the documentation for the national TB program. Descriptive analysis was applied to determine the TSR in various patient groups. Further, logistic regression was performed to determine factors influencing the TSR in new and relapsed cases versus all other previously treated cases. A subgroup analysis for only microbiologically confirmed pulmonary TB was added. The study included 3969 patients. The TSR increased from 68.3% in 2010 to 80.8% in 2017 (p < 0.001). Mortality (11.2%) mainly occurred in early treatment months, while loss to follow-up (5.9%) increased towards later treatment months. Risk factors for low TSR were advanced age, positive HIV status, long travel distances (>100 km) to the clinic, and late treatment refill. The TSR in the Forest Region of Guinea remained below the WHO goal of 90%. Reaching this target remains a challenge in rural areas with high early mortality and increased risk of loss to follow-up.